P20: MDMA and life-threatening complication: About of 2 unusual cases

Abstract

Objective Abuse of MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy, a psychoactive stimulant has been going through a revival over the last recent years. We report here 2 unusual cases in terms of seriousness and/or clinical patterns. Case history The first case involved a 30-year-old man, with a history of occasional cannabis use, who took a “bomb” of MDMA while attending a music festival. Two hours later, he had a 45-min tonico-clonic seizure; he was admitted to an Intensive care unit for coma, tachycardia and hyperthermia (42,5 °C). He had severe rhabdomyolysis complicated by renal failure, cytolysis, severe thrombocytopenia, and disseminated intravascular coagulation. On Day 8, he presented with compartment syndrome that required fasciotomy. Haematological disorders and renal failure disappeared within 4 days, but he stayed in intensive care unit during 12 days because of recurrence of hyperthermia and agitation at each sedation withdrawal attempts. He finally recovered after 21 days of hospitalisation. The second case involved a 31- year-old man, without history of MDMA use, who was hospitalised for a bilateral renal thrombosis 24 hours after the intake of 3 bombs of MDMA that he had taken for “relaxing”. Abdominal scanner and Doppler showed bilateral arterial renal thrombosis with kidney ischemia. Arrhythmia, endocarditis and embolic cardiac disease were ruled out. He was discharged 20 days later without renal sequellae. Methods During hospitalisation, urine samples were collected 24 hours and five days after the supposed ingestion in case 1 and case 2, respectively. In case 2, the “bomb” of MDMA has been collected for analysis. Powder has been analysed by LC-DAD, LC-MS and GC-MS toxicological screening method. Amphetamines were determined by liquid chromatography – mass spectrometry (LCMS/ MS) after SPE extraction. Urine toxicology screen have been performed by immunochemistry. Results For case 1, quantitative toxicological analysis showed a urine MDMA concentration higher than 10 000 ng/mL and MDA at 984 ng/mL. For case 2, the powder analysis showed 78 % of MDMA, this latter being the only active compound in the “bomb”; the estimated quantity of MDMA per “bomb” was 58 mg. Urine toxicology screen was only positive for cannabis. Conclusion Both cases were unusual in terms of seriousness and/ or clinical patterns. While serotoninergic syndrome with hyperthermia and rhabdomyolysis is a well-known life threatening complication of MDMA intoxication, the duration of symptoms in Case 1 is uncommon. In Case 2, renal thrombosis is rare, only one case has been previously published. Both cases concerned first-ever use of “bomb” of MDMA by wellintegrated young adults, and confirmed the need to inform the public about the potential dangers of MDMA.